General Flashcards
(80 cards)
1
Q
Worst risk factor for angina?
A
DM
2
Q
Normal LVF
A
> 50%
3
Q
Vessel assoc w/ I, aVL, V5/V6 (lateral)
A
Circumflex
4
Q
Vessel assoc w/ II, III, aVF (inferior)
A
Right coronary
5
Q
Vessel assoc w/ V1 and V2 (septal)
A
LAD
6
Q
Vessel assoc w/ V3 and V4 (anterior)
A
LAD
7
Q
Treating angina/CAD
A
ASA, BB (2: CCB), NTG
8
Q
Definition of ACS
A
Clinical manifestions of plaque rupture and coronary occlusion
Includes USA, NSTEMI, STEMI
9
Q
Treat USA
A
Admit, IV, O2
ASA, clopidogrel, BB, LMWH, nitrates
10
Q
Atypical MI sx occur in what populations
A
Elderly, women, DM
11
Q
EKG markers for cardiac ischemia
A
Peaked T waves, ST elevation, Q waves, T wave inversion, ST depression
12
Q
Time frame of trops
A
Increase in 3-5 hours, normal in 5-14 days (peak 24-48 hours)
13
Q
Post MI free wall rupture
A
Within 2 weeks (usually 1-4)
Hemopericardium and tamponade
14
Q
Post MI IV septum rupture
A
Within 10 days
15
Q
Post MI papillary muscle rupture
A
New mitral regurg
RCA (inferior MIs)
16
Q
Post MI pseudoaneurysm
A
Incomplete free wall rupture
17
Q
Dressler
A
Autoimmune pericarditis
6-8 weeks
18
Q
Signs of left sided heart failure
A
Left PMI, S3, S4, crackles/rales at the bases
19
Q
Signs of right sided heart failure
A
Edema, JVD, hepatomegaly/hepatojugular reflux,
20
Q
Ddx for flash pulmonary edema
A
PE, asthma, pneumonia
21
Q
Cardioversion vs defib
A
Cardioversion is synchronized (dont hit the T wave)
Defib vfib
22
Q
Treat acute/unstable afib
A
BB for rate control
<48 hrs: shock
>48hrs or unknown: TEE or anticoagulate for 3 weeks, shock
Both get anticoagulation for 4 weeks after
23
Q
Multifocal atrial tachycardia
A
Severe pulmonary disease
3 different P wave morphologies
24
Q
Most common arrhythmia associated with dig toxicity
A
Paroxysmal atrial tachycardia with 2:1 block
25
WPW
Accessory conduction pathway
| Narrow complex tachycardia, short PR interval and delta wave
26
Cannon A waves
When atria and ventricle contract together
| Seen in 3rd AVB, pulmonary hypertension, VT
27
Sick SInus Syndrome
Spontaneous sinus bradycardia
| Elderly
28
ECG changes seen in pericarditis
1. Diffuse ST elevation and PR depression
2. ST normal
3. T wave inversion
4. T wave normal
29
CP that improves with sitting up and leaning forward
Acute pericarditis
30
Kussmaul sign
JVD fails to decrease during inspiration
| Right sided heart problems, PE, restrictive pericarditis
31
Pericardial knock
abrupt cessation of ventricular filling
32
When will a CXR show a pericardial effusion?
>250mL of fluid
| "water bottle" appearance
33
Cardiac tamponade fluid amounts
200mL quickly or 2L slowly
34
Impairment in cardiac tamponade
Ventricular filling during diastole
35
Clinical features of tamponade
Elevated JVP (prominent x with absent y)
Narrowed pulse pressure (decreased stroke volume)
Pulsus paradoxus (>10mm decrease in atrial pressure during inspiration)
Muffled heart sounds
Cardiogenic shock (tachypnea, tachycardia, hypotension)
36
EKG of tamponade
Electrical alternans (not sensitive or specific)
37
Cause of mitral stenosis
Almost all are rheumatic heart disease
38
Sequela of long standing mitral stenosis
Asymptomatic until area is ~1.5cm2
| Pulmonary HTN, right sided heart failure, afib
39
Murmur of mitral stenosis
Opening snap followed by a diastolic rumble (murmur increases in length as stenosis worsens)
Distance between S2 and opening snap closer as stenosis worsens
Murmur followed by a loud S1
40
Common life things that cause symptomatic mitral stenosis
Exercise and pregnancy
41
Echo of mitral stenosis
Left atrial enlargement
Thick, calcified valve
"fish mouth" opening
42
Sequela of long standing aortic stenosis
Cardiac output fails to increase with exertion when area falls below 0.7 (<0.8 considered severe)
LVH/LV dilation -> LV dysfunction -> pulling apart of mitral valve -> mitral regurg
43
Causes of aortic stenosis
Bicuspid aortic vale, calcification with age, rheumatic fever
44
Murmur/Signs of aortic stenosis
Harsh crescendo-decrescendo murmur that radiates to carotids
Soft S2, S4
Parvus et bardus (delayed carotid upstroke)
Precordial thrill
45
Murmur/Clinical features of aortic regurg
Diastolic decrescendo murmur at the left sternal border
Wide pulse pressure (increased systolic BP)
Corrigan/water hammer pulse (rapidly increasing pulse that collapses suddenly)
Austin Flint murmur (low pitched diastolic rumble)
46
Clinical features of tricuspid regurg
```
Looks like RVF (edema, hepatomegaly etc)
Pulsatile liver
Prominent V waves in JVP
Blowing, holosystolic murmur
Afib
```
47
Classifying aortic dissection
A: proximal (even if as an extension from descending)
B: Distal; just descending (distal to subclavian)
48
Manage aortic dissection
BB immediately (lower HR and force of EF), sodium nitroprusside to lower systolic BP
A: surgical
B: medical
49
Sx of acute arterial occlusion
Pain, pallor, polar (cold), paralysis, paresthesias, pulselessness
50
Venous ulcers
Not as painful as arterial, over medial malleolus
51
Sx of peripheral vascular disease
(arterial insufficiency)
Claudication, pain at night (distal metatarsals; improves with foot over bed)
Diminished pulses, hairless, thick toenails
52
Definition of cardiogenic shock
BP <90 with urine output <20mL/hr and adequate LV filling pressure
53
Pathophys of chronic bronchitis
Excess mucous production -> inflammation and scarring, smooth muscle hyperplasia -> obstruction
54
Pathophys of emphysema
Smoke increases activated PMNs and macrophages -> release protease/elastase (relative deficiency of antiprotease)
55
LFTs in COPD
FEV1/FEV decreased
FEV1 decreased
TLC increased
56
Esophageal perforation
Often seen with pedestrian vs vehicle trauma or instrumentation
Green discharge from tube
Dx with esophagography
57
Fetal hydantoin syndrome
Cleft lip/palate
Distal phalangeal hypoplasia
Microcephaly
58
Murmur most likely to be heart with infectious endocarditis from IVD use
Holosystolic murmur that increases with inspiration
59
Friedreich Ataxia
GAA repeats; abnormal frataxin protein (highly expressed in brain, heat and pancreas)
Neurologic dysfunctions, cardiomyopathy, DM
Loss of dorsal spinal column -> decreased vibration and position
Kyphoscoliosis and pes cavus
60
Acute cerebellar ataxia
Acute onset following infection
| Ataxia, nystagmus and dysarthria
61
Pancoast tumor
Shoulder pain, Horner Syndrome, C8-T2 problems, supraclavicular lymph nodes
62
FAS
Short palpebral fissures, thin upper lip, smooth filtrum
Growth retardation
Occurs via inhibition of NMDA and over activation of GABA
63
Post surgery fever, tremor, lid lag but no muscle rigidity
Thyroid storm (even if no known thyroid disease)
64
Cupping of optic disc
Glaucoma
Close is acute
Open is chronic
65
Acalculus cholecystiti
Seen in trauma, surgery, ICU patients, prolonged fasting
Fever, leukocytosis, elevated LFTs
Abdominal US
66
Sickle cell can lead to what kind of kidney damage
Renal papillary necrosis (and renal medullary carcinoma)
67
Sx of adrenal insufficiency
HyperK, hypoNa, hypotension
| Hyperpigmentation, thinning hair
68
Liver sequelae of polycythemia vera?
Budd Chiari syndrome due to venous thrombosis (abdominal US)
69
New onset, drug resistant HTN
pheochromocytoma
70
New dx pseudogout; next step?
R/O secondary causes: hyperparathyroidism, hypothyroidism, hemochromatosis
71
Kidney issues with long term analgesic use
Tubulointersitial nephritis and papillary necrosis
72
Most common anatomical location for ectopic foci causing afib
pulmonary veins
73
Mediastinal mass with elevated bHCG and AFP
nonseminomatous germ cell tumor
74
Associations predisposing to membranous nephropathy
SLE and HepB
75
Associations predisposing to FSGS
HIV, heroin, sickle cell
76
NT in Huntingtons
GABA
77
Huntingtons
Chorea, delayed saccades, depression, loss of executive function
78
Concerning sequela of prong longed seizure
Cortical necrosis
79
Video vs esophageal motility in evaluating difficulting swallowing
Associated coughing/choking/difficulty initiating, do the video
80
Medullary thyroid cancer is associated with
RET
| cancer of parafollicular (calcitonin secreting) cells
